House of Hope Assisted Living

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Nicholas Reed arrived on 08/07/26 for an unannounced inspection to follow up on a substantiated complaint investigation. On 07/15/2025, the Department concluded a complaint investigation regarding the following allegation: Resident sustained multiple unstageable pressure injuries due to staff neglect. The licensee was cited for California Code of Regulations (CCR) 87615(a)(1) Prohibited Health Conditions. During the non-compliance conference on 02/20/26, the licensee was informed that the complaint was referred to the Department’s legal branch for possible legal action including additional civil penalties, administrative decertification, and a non-immediate exclusion of the licensee. The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. The Welfare and Institutions Code Section 15610.67 defines serious bodily injury as “an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by the facility not providing appropriate care and supervision related to the development, prevention and management of a Stage 3 sacral pressure injury and wounds to both knees and feet, all of which required wound care and treatment. Today, 08/07/26, the Department will be issuing a civil penalty per Health and Safety Code § 1569.49(f) for a violation that the Department constitutes a serious bodily injury in the amount of $10,000. Exit interview conducted. A copy of the report issued. Appeal rights provided. Iulia Laktinova's signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D.the state’s words, verbatim · CDSS document, Aug 7, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an unannounced annual inspection. LPA met with caregiver, Iulia Laktionova ad advised her the visit. Administrator, Dianna Tahmazyan was advised over the telephone, but could not attend the the annual inspection on this date. At approximately 10:30am, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms and carbon monoxide are dual and interconnected. There is one fire extinguisher located in the kitchen. It was purchased on January 12, 2026. KITCHEN: The kitchen is equipped with a refrigerator, microwave, stove/oven and sink. There is also a mini refrigerator, that was observed to be locked, where insulin is being stored. LPA observed an adequate supply of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). An emergency supply of water is also kept in the kitchen. Sharps and knives were observed locked in a kitchen drawer. Cleaning supplies kept underneath the kitchen sink. BEDROOMS: There are three (3) bedrooms designated for resident use. Bedrooms were furnished with beds, night stand, chairs, dresser, bedding and linen. Bedrooms are observed to have sufficient lighting and closet space. Passageways were clear of obstruction. BATHROOMS: The facility has two (2) bathrooms. LPA observed the bathrooms to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms were measured between 111 to 112 degrees. No cleaning supplies were observed in the bathroom at this time. COMMON AREAS: Facility has one room designated for the living room/activity area. It was equipped with living room furniture, a television, and a coffee table. There is no fireplace. Dining area is located by the kitchen. Furniture is observed to be maintained and in good repair. Floors were mopped and clean. GARAGE/LAUNDRY ROOM: The garage is attached to the home, but no resident access. The two entries, the main and side door is locked at all times. Laundry room is also located in the garage, along with another room designated as staff workstation. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. The backyard of the facility has a patio and backyard furniture to accommodate the residents. There is a swimming pool that is fenced with a gate that is kept locked at all times. The fence installed to keep residents out of the swimming pool area is approximately 5 feet high throughout the parameters. A key is required to unlock the padlock to gain entry to the swimming pool as it is kept locked at all times. Adjacent to the swimming pool was another building, which is used for storage. LPA inspected this building and observed wheelchairs and beds, that were left from prior residents, and no longer in use. Medications: Medications are stored locked in a kitchen cabinet. Medications and medication records were reviewed for proper storage and documentation. Resident Files: Resident files are kept locked in the medication cabinet. LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: Staff files are also kept locked in the medication cabinet. LPA conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit. Exit Interview Conducted and a copy of this report issued.the state’s words, verbatim · CDSS document, Mar 28, 2026

Allegation investigated: Resident sustained unexplained injuries resulting in hospitalization and contributing to death.

Licensing Program Analyst (LPA) Michael Cava conducted a subsequent visit to the facility to conclude the investigation regarding the above allegation. LPA met with staff, Iulia Laktinova, and advised her of the complaint. In regards to the above allegation, it was reported that R1 suffered a fall at the facility on or around 01/22/24. As a result of this fall, R1 suffered multiple unexplained injuries, including a broken jaw and had fallen into a coma. R1 then expired on 01/26/24. The ten (10) day visit was made by LPA Melissa Spaeth on 02/15/24, followed by a subsequent visit by LPA Cava on 03/28/25. LPAs investigation consisted of a health and safety check, interviews with residents and record review. The above noted allegation was referred to and initially accepted by CCLD Investigations Branch (IB) as an assignment to obtain records, then eventually accepted as a full nvestigation on 04/14/25. Case was assigned to IB Investigator, Johhny Canto. IB's investigation consisted of the following: • On 03/25/25, IB obtained a copy of R1’s Death Certificate and on 04/17/25, Medical Records were Unsubstantiated obtained. Review of death certificate revealed that R1 expired on 01/26/24. The cause of death was Consequences of Blunt Trauma due to ground level fall. Per medical records, on 01/22/24 R1 was admitted to the hospital due to a blunt trauma to the head. Further review of medical records reveal that R1 appeared to have been down for an extended period of time, outside in the rain. R1 had suffered intracranial hemorrhage following injury with prolonged (more than 24 hours) loss of consciousness with return to pre-existing conscious level, resulting in death. On 05/01/25: Investigator Canto interviewed facility administrator, Gayane Alaberkyan. This interview revealed that on or around 01/22/24, facility staff (S1) informed her that R1 had a fall. Administrator had no direct information as to the cause of the fall, however S1 advised her that there was a loud noise coming from the hallway, and when S1 went to follow up, R1 was observed on the floor. Paramedics called and R1 was sent to the hospital. On 05/20/25: Interview with Reporting Party (RP) was conducted to confirm the allegation. Between 12/08/25 and 12/30/25. R1’s available medical records were referred to and reviewed by CCLD Clinical Consultant. It was revealed that “There is no adequate evidence to conclude whether the facility would be culpable for death due to a fall”. Today's investigation consisted of additional interviews with three (3) of four (4) residents between 9:30am-10:30am. One resident was at dialysis and could not be interviewed. LPA also interviewed one (1) of one staff and two (2) administrators, over the telephone between 10:30am to 11:30am. In addition to interviews, LPA conducted a physical plant inspection between 11:30am to 12:30pm. Based on the information obtained, there is insufficient evidence to prove that R1 succumbed to unexplained injuries and expired due to these injuries on 01/26/24. Therefore, the allegation is deemed Unsubstantiated at this time. No immediate health and safety hazard is noted during this visit. Exit interview conducted and a copy of report was issued.the state’s words, verbatim · CDSS document, Feb 14, 2026 · control 31-AS-20240214113238

Allegation investigated: Resident sustained multiple unstageable pressure injuries due to staff neglect

****This is the addendum of licensing report originally issued on 2/13/2025. This report is created to make a correction to the previous report due to further investigation of available inormation **** At approximately 10:15 a.m. on 07/15/25 LPA Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and disclosed the reason for the visit. It was alleged that on 05/02/24, during admission to the hospital, Resident #1 (R1) was observed to have multiple pressure injuries, Stage 3 and above. The investigation was initiated on 05/21/24 by the LPAs Angela Panushkina and Huma Rahimi and continued by the Senior investigator (SI) from CCLD Investigation Bureau Dennis Douglas. During the course of investigation, on 06/07/2024 SI Douglas conducted a visit to the facility. At the time of visit between 10:00am and 10:55am, SI spoke with five facility residents. At 11:40am, SI made an attempt to make a phone contact and speak with other residents. Prior to this visit on 04/08/25, Licensing Program Manager (LPM) Naira Margaryan conducted a full file review of R1’s medical records before and after admission to the facility. Interview of the residents did not reveal any pertinent Substantiated information regarding the allegation. Interview with the Administrator revealed that R1 arrived at the facility from Las Vegas after they were released from the hospital there. R1 was a resident in the facility between 03/15/2024 and 05/02/2024. At the time of admission, R1 had a condition in their eyes and sores down their legs. Furthermore, the Administrator had knowledge of R1’s pressure injuries. R1 had no medical insurance, so the Administrator paid for R1's initial doctor’s visit. A review of medical records from the hospital in Las Vegas where resident was retained between 02/07/24 to 03/12/24 did not reveal any information to conclude that R1 had pressure injuries prior to admission. A review of medical records from Mission Hills Hospital conducted by SI and LPM revealed that at the time of admission to the Mission Hills Hospital, on 05/02/24, R1 had at least one (01) stage 3 pressure injury on their limbo-sacral area and one (01) Unstageable pressure injury on their Sacro-coccyx area. Based on interviews and record review, there is sufficient information and evidence to verify the validity of the complaint. Hence the allegation is SUBSTANTIATED at this time. Under Title 22, Division 6 Chapter 8 the following citation will be issued and documented on the LIC9099-D. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 15, 2025 · control 31-AS-20240520161421

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Jul 16, 2025

87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted...: (1) Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by: Based on interviews and record reviews, the licensee dod not comply with the section cited above by R1 developing multiple pressure injuries that included Stage III pressure injuries while under the facility care which posed an immediate health and safety risk to the resident in care.the state’s words, verbatim · CDSS document, Jul 15, 2025

Plan of correction: Licensee to conduct an in-service training for the cited section and submit proof by POC due date.

Allegation investigated: Staff did not provide adequate meals to resident in care Staff did not treat resident with respect Staff do not answer facility phone

Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to continue the investigation regarding the above allegations. LPA met with staff, Oleh Markiv, and advised him of the investigation. The administrator, Gayane Alaberkyan, was advised over the telephone. The initial visit to this investigation was made by LPA Melissa Spaeth on 01/15/24. Today's investigation consisted of interviews with the administrator, staff, and residents. LPA also conducted a physical plant inspection, and requested for copies of facility records for review. Staff did not provide adequate meals to resident in care: Regarding the allegation, it was reported that facility staff would eat up all the food, and give residents very little to eat. Interviews with three (3) of three residents deny the allegation, stating food service is adequate. They receive three meals per day, including snacks in between. Moreover, the three residents, interviewed Unsubstantiated deny not getting enough food, stating food service is sufficient. LPA inspected the physical plant, which includes the kitchen, and observed a sufficient amount of perishable and non-perishable food supply. Based on the information obtained, there was insufficient evidence to prove that staff do not provide adequate meals to the residents in care. Therefore, the allegation is deemed Unsubstantiated at this time. Staff did not treat resident with respect: In regards to the allegation, it was reported that staff do not speak with residents, and the and only spoke a foreign language around them. Interviews with three (3) of three residents deny the allegation. All three residents stated they have no complaints regarding any language barrier, and they are able to communicate with their caregiver. During today's visit, LPA observed staff, Oleh Markiv, interacting and communicating with the residents, catering to their needs. Based on the information obtained, there was insufficient evidence to prove that staff do not treat residents with respect. Therefore, the allegation is deemed Unsubstantiated at this time. Staff do not answer facility phone: In regards to the allegation, it was reported that staff do not reply or answer the facility phone when an outside call is placed to contact someone there, or the facility phone line is disconnected. Prior to the day's visit, LPA placed a call to facility with number listed on file, and was answered by staff. LPA also tested the common/public phone while at facility, and observed it to be functional. Moreover, LPA interviewed three (3) of three residents, who deny the allegation. All three residents stated they receive and make calls. Phone calls for them are answered and given to them when made. In addition, two (2) of the three residents have their cell phones if they need to place personal calls. Based on the information obtained, there was insufficient evidence to corroborate the allegation that staff do not answer facility phone. Therefore, the allegation is deemed Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Mar 28, 2025 · control 31-AS-20240214113238

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 1/28/2025, Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced annual inspection. LPA was greeted by caregiver and disclosed the reason of the visit. Administrator was contacted. Administrator will not be available to meet LPA. There are currently three (3) residents who reside at this facility. This facility is approved for six (6) non-ambulatory of which one (1) may be bedridden. Approved hospice waiver for six (06) residents. At approximately 11:30am, LPA toured the facility with staff member and observed the following. LPA observed dual smoke/carbon monoxide detectors that are hard wired and interconnected. Smoke detector was tested @1:15pm and was observed to function properly. The fire extinguisher is located in the kitchen, appeared to be fully charged and was purchased on July 16, 2024. KITCHEN: The facility has a Kitchen area that is equipped with a refrigerator, microwave oven and sink. There is also a mini refrigerator, that was observed to be locked, where insulin is being stored. There is an adequate supply of perishable and nonperishable food and dining ware to accommodate a maximum capacity of six (6). An emergency supply of water was also observed in the kitchen. Sharps and knives were observed locked in a kitchen drawer. BEDROOMS: There are three (3) bedrooms designated for resident use. Bedroom #1 is currently occupied by two (2) residents, and bedroom #2 is occupied by one (1) resident. Bedroom #3 is vacant. All three rooms were furnished with beds, night stand, chairs, dresser, bedding and linen. All three bedrooms have sufficient lighting and closet space. BATHROOMS: The facility has two (2) bathrooms. LPA observed the bathrooms to have the proper fixtures, grab bars, and non-skid mats. The hot water delivered in the bathrooms measured at 115.2 degrees. No cleaning supplies were observed accessible in the bathroom at this time. COMMON AREAS: Facility has one room designated for the living room/activity area. It was equipped with living room furniture, a television, and a coffee table. There is no fireplace. Dining area is located in the kitchen. LPA observed all the furniture in common areas to be in good repair. LAUNDRY ROOM: The laundry room is located in the garage. Cleaning supplies were stored away and inaccessible to the residents. MEDICATIONS: Medications are stored locked in one of the kitchen cabinet. SURROUNDING GROUNDS: The driveway, passageways and entrance to the home was clear of obstruction. The backyard of the facility has a patio and backyard furniture to accommodate the residents. There is a swimming pool that is fenced with a gate that will be kept locked at all times. The fence installed to keep residents out of the swimming pool area is approximately 5 feet high throughout the parameters. A key is required to unlock the padlock to gain entry to the swimming pool as it is kept locked at all times. Adjacent to the swimming pool was another building, which is used for storage. LPA inspected this building and observed used wheelchairs and beds. Facility Records: At 2:30PM LPA conducted review of resident files and staff records. LPA reviewed three (3) out three (3) resident files and two (2) staff records were reviewed to ensure compliance. During staff records review LPA observed staff (S1) who was present at the facility giving care to residents, did not have a staff file. S1 is not associated with the facility. LPA observed Administrator's certificated has expired. Pursuant to Title 22 CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit Interview Conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 28, 2025

Allegation investigated: Staff hit resident with an object Staff are unable to communicate with resident due to language barrier Staff do not ensure resident receives adequate medical care Staff do not provide resident with adequate food service Staff do not dispense medication to resident as prescribed

On 09/03/24, at 9:55am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Caregiver, Oleh Markiv. LPA explained the purpose of this visit was to gather additional information and deliver findings for this complaint. On 02/15/2024, Licensing Program Analyst (LPA) Melissa Spaeth initiated the complaint investigation. On 09/03/24, LPA Saucedo asked for the census, staff, and resident rosters. On 09/03/24, LPA Saucedo interviewed additional staff and residents, conducted a physical tour, gathered additional information, and delivered findings. LIC 9099C-continued Unsubstantiated Regarding the allegation: Staff hit resident with an object. It is being alleged that one (1) of the staff at the facility hit the resident with a hose. Three (3) out of three (3) residents confirmed that they have never been hit by any of the staff. One (1) of the residents-resident #2 (R2) confirmed that they were there the day one (1) of the residents alleged that one (1) of the staff hit them. In addition, R2 showed LPA the police officer card that states the police arrived to do a welfare check and there was no evidence of abuse for any of the residents which was written in the back of the police card. LPA interviewed two (2) out of two (2) staff that confirmed they have never hit any of the residents. LPA also spoke to one (1) of the staff at Bridge Health Center (a placing agency) the agency that placed Resident # (R1) at the above facility and staff at the agency stated, “R1 would scream and yell down the hallway about staff hitting them here and would cause several other issues.” Therefore, based on the LPA's observations, staff and resident interviews, and record reviews the above allegation(s) above is UNSUBSTANTIATED at this time. Regarding the allegation: Staff are unable to communicate with resident due to language barrier. It is being alleged that the staff only speak English. Three (3) out of three (3) residents confirmed that they do not have a language barrier and they do understand what the staff is saying. Resident #2 (R2) did state that resident #1 (R1) did understand English but refused to speak English and only wanted to speak Spanish. LPA confirmed with the administrator of the above facility and with one (1) of the staff at Bridge Health Center that R1 did understand and speak English but refused to speak English at times and R1 never had any issues communicating with them. Therefore, based on the LPA's observations, staff and resident interviews, and record reviews the above allegation(s) above is UNSUBSTANTIATED at this time. Regarding the allegation: Staff do not ensure resident receives adequate medical care. It is being alleged that the staff are not providing medical assistance to the resident. Three (3) out of three (3) residents confirmed that they do receive adequate medical care. In addition, Resident #3 (R3) did state that home health comes to help them at the above facility. Two (2) out of two (2) staff confirmed that when medical care is needed, they do send the resident to the doctor and/or provide the adequate care. During LPA's visit Home Health did arrive to provide care for R3. Therefore, based on the LPA's observations, staff and resident interviews, and record reviews the above allegation(s) above is UNSUBSTANTIATED at this time. LIC9099C-continued Regarding the allegation: Staff do not provide resident with adequate food service. It is being alleged that the resident did not receive their breakfast. Three (3) out of three (3) residents confirmed that they do receive three (3) meals a day-Breakfast, Lunch and Dinner. Two (2) out of (2) staff confirmed that all meals are provided to every resident along with snacks throughout the day. During LPA's visit, one (1) of the staff was providing lunch to the residents. Therefore, based on the LPA's observations, staff and resident interviews, and record reviews the above allegation(s) above is UNSUBSTANTIATED at this time. Regarding the allegation: Staff do not dispense medication to resident as prescribed. It is being alleged that the resident did not receive their proper dosage of medication. Three (3) out of three (3) residents confirmed that they do receive their proper medication and do not have any issues with the dosage or distribution. Resident #2 (R2) whom has been at the above facility the longest did confirm that they have never had any issues with the medication being provided. Two (2) out of two (2) staff confirmed that medication is dispersed properly to each resident. LPA was able to review the medication distribution for each resident and it was correct. Therefore, based on the LPA's observations, staff and resident interviews, and record reviews the above allegation(s) above is UNSUBSTANTIATED at this time. An exit interview was conducted, no citation(s) were issued for the above allegation(s), and a copy of this report was given to the Caregiver.the state’s words, verbatim · CDSS document, Sep 3, 2024 · control 31-AS-20240214144751

Type of visit: Case Management - Deficiencies

On 09/03/24, Licensing Program Analyst (LPA) Gina Saucedo, conducted unannounced, subsequent visit to this facility in conjunction with a complaint control #31-AS-20240214144751. LPA met with the Caregiver, Oleh Markiv and explained the reason for the visit. During the physical tour, LPA conducted a review of records and no incident report was sent to Community Care Licensing Department-(CCLD) for any of the residents. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D. Exit interview conducted, appeal rights and copy of report signed and delivered to the Caregiver.the state’s words, verbatim · CDSS document, Sep 3, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(a)1(A) · Plan of correction due date: Sep 4, 2024

87211 (a)(1)(A)Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports... including, but not limited to, the following:(1)A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below... This requirement is not met as evidenced by: Based on the LPA observation and interviews the licensee/administrator did not ensure resident reports to be submitted to CCLD from the above facility involving multiple incidents which poses an Immediate Health, Safety or Personal Rights risks to persons in care.the state’s words, verbatim · CDSS document, Sep 3, 2024

Plan of correction: An Unusual Report is to be sent to Community Care Licensing Department within seven (7) days regarding a death report and/or resident injuries/hospitalizations while in care. POC 09/04/24

Allegation investigated: Staff does not ensure resident is accommodated with requested bed.

On 06/11/24, Licensing Program Analyst (LPA) Leizl de la Cerra made an unannounced visit to this facility to investigate a complaint. LPA identified herself at the door when greeted by the male staff who identified himself as a caregiver for the facility and provided his name. LPA was granted access and explained the reason for the visit. The administrator was not available and S1 proceeded to call the administrator by phone. It was alleged that resident #1 (R1) has been requesting for a new bed with bed rails since May 21st, 2024 and did facility did not accommodate R1. At the time of this visit at (time) LPA requested S1 to provide facility records included but not limited to the residents and staff roster and resident’s files. S1 was unable to provide requested records and stated that he has no knowledge of where any of the records were. At 10:25am LPA conducted a facility tour. During facility inspection, LPA observed a total of (4) four residents in care of the facility. CONTINUED to LIC9099-C Unsubstantiated To investigate the allegation at 10:38a, LPA interviewed resident (R1) at 11:00am, LPA spoke with the facility staff and at (time) LPA discussed the allegation with the Administrator over the phone. LPA DeLACerra observed and assessed R1 during interview. R1 is an amputee (Left foot amputated) and is in hospice care. R1 was already using hospital bed. L PA observed that the bed for R1 was in good repair. R1 revealed that they are residing in the facility since May 21, 2024. R1 was placed in bedroom #2 with a hospital bed. Resident verified that currently they are receiving hospice services. On 05/22/2024, R1 was given a suggestion by the hospice worker to request a new hospital bed with bedrails. Within the same day, R1 followed the suggestion, and requested from a facility staff #2 (S2) who is administrator’s designee, a new hospital bed with bed rails. R1 verified that they had no prescription for a new hospital bed or bed rails issued for him by a physician. R1 also stated that the bed rails would help him for mobility due to being an amputee. The staff indicated that R1’s request was revealed to the hospice agency. Since R1 already had hospital bed, they ordered half bed rail for R1’s mobility. During the course of investigation while interviewing R1, a delivery person came from AAA Healthcare Products, Inc. and delivered the half bed rails for R1 in R1’s room. Staff revealed that R1’s request was discussed with the hospice agency. Bed rails were ordered on 06/07/2024 and delivered today on 06/11/2024. LPA visibly witnessed the delivery of the bed rails. Based on observation, interview and record reviews, there was not enough supporting information to confirm the allegation. Therefore, the allegation deemed unsubstantiated at this time. During this investigation, LPA noted other Title 22 Deficiencies. Therefore, Case Management visit was conducted to address other deficiencies unrelated to the complaint. Exit interview was conducted. Copy of report was signed by the facility staff. Due to the Administrator not being present at the facility, the copy of report will be delivered to the Administrator via e-mail.the state’s words, verbatim · CDSS document, Jun 11, 2024 · control 31-AS-20240605130632

Type of visit: Case Management - Deficiencies

This Case Management visit is conducted in conjunction with complaint investigation visit conducted today. (Complaint 31-AS-20240605130632). The purpose of this Case Management visit is to address the deficiencies that were observed during the complaint investigation not related to the complaint. LPA greeted by the staff #1 (S1) who identified himself as a caregiver for the facility. LPA explained the reason for the visit and requested the caregiver to inform the Administrator about Licensing Visit. S1 provided their names and LPA Dela Cerra noted that S1 did not have a criminal record clearance and association to the facility. In addition, upon further review of recent licensing reports, LPA noted that during Case management visit conducted by the Department on 05/21/2024, the facility was cited for allowing a same individual, S1 to work in the facility without criminal record clearance and association. In addition, while reviewing residents’ records, LPA observed that the records were not complete and/or current. As per history of facility licensing reports, the Administrator of record is never present at the facility and Licensing representatives were greeted either by the designee or by the caregivers. LPA De La Cerra contacted the Administrator over the phone and informed that at the time of this visit the facility will be cited for the following Title 22 Deficiencies. During the investigation and record review, LPA observed the following: CONTINUED to LIC809-C · On 5-21-2024 the facility was in violation of CCR 87355(e)(1) and was issued a citation. S1’s name is identified as the individual in violation on the LIC421BG form. At the time of this visit S1 is still present at the facility without obtaining criminal record clearance and association. In addition to the citation $3,000.00 will be issued to the facility. · R1's and other residents facility files/records are incomplete. · Facility Administrator does not have required qualifications and is not present in the facility as required by Title 22 Regulations. Therefore, Pursuant to the California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiencies were cited and recorded on LIC809D. The Administrator was informed over the phone that the staff present at the facility without criminal record and association must be removed from the facility as soon as possible. No other immediate health and safety hazard is noted during this visit. Exit interview was conducted, the report was signed by the facility staff. However, due to absence of the Administrator a copy of report will be delivered via e-mail.the state’s words, verbatim · CDSS document, Jun 11, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506 · Plan of correction due date: Jun 25, 2024

Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility….readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by; Licensee did not ensure to maintain complete and current records for facility residents. This posses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 11, 2024

Plan of correction: Administrator shall complete the Resident Records records for all residents in care and submit proof to CCL/LPA by POC due date. POC due date 6/25/2024.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405 · Plan of correction due date: Jun 25, 2024

Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) to (7)... all requirements apply. (2) Knowledge of & ability to conform to the applicable laws...This requirement is not met as evidenced by. The Licensee failed to follow Title 22 Regulations regarding staffing requirements. This posses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 11, 2024

Plan of correction: The administrator will enroll and take more administrator courses and provide proof that training courses are secured and submit proof to CCL/LPA by POC due date. POC due date 6/25/2024.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(f)(1) · Plan of correction due date: Jun 12, 2024

Criminal Clearance (f) Violation of Sec. 87355(e) shall result in an immediate... civil penalties(1)Subsequent violations within a twelve (12) mo. period will result in a civil penalty ($100)a day for a max of thirty 30 days.This requirement is not met as evidenced by Licensee failed to obtain criminal record association for S1. This is the second 2nd offense for S1.the state’s words, verbatim · CDSS document, Jun 11, 2024

Plan of correction: LPA requested admin to remove S1 from facility asap. Within 24 hours licensee must inform RO that S1 is removed and will not return to facility without criminal record clearance and association. A $3,000,00 civil penalty will be assed at the time of this visit.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Angela Panushkina and Huma Rahimi conducted unannounced visit to this facility in conjunction with a complaint control #1-AS-20240520161421. LPA met with Staff #1 (S1) who granted access to facility. The Administrator was contacted and LPA was informed that she's out of town and cannot come to the facility. At 10:25am, the designee, Arman Petrosya, arrived and LPAs explained the reason for the visit. During the visit, LPAs was informed that R1 had a difficulty breathing on or before 05/02/2024. 9-1-1 was called and R1 was taken to the hospital. However, no incident report was submitted to the Community Care Licensing Department (CCLD) in a timely manner. LPA reviewed all incident reports on a system and did not observe an Incident Report regarding R1. In addition, the Administrator admitted that no incident was submitted to the Regional Office (RO). Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence. LPAs informed the Administrator that all staff members are mandated reporters and they are all responsible for reporting. LPA informed the Administrator to submit an incident report that occurred on or before : 05/02/24 (one incident) Moreover, LPAs were informed the S1 have been working at this facility for two (2) weeks. However, LPAs reviewed LIS and did not observe S1 being associated with the facility. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D. Exit interview conducted, appeal rights and copy of report signed and delivered.the state’s words, verbatim · CDSS document, May 21, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: May 22, 2024

Criminal record clearance: (e) All individuals subject to a criminal record review... (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above by hiring one (1) staff member on 05/13/2024 without fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 21, 2024

Plan of correction: Licensee agreed to complete S1's fingerprints and associate the staff to the facility. Copy of proof will be submitted to LPA by POC date. Civil penalty assessed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)A,B&D · Plan of correction due date: May 22, 2024

Requirements (a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency and to the person... ... any of the events specified in (A), (B) & (D)... This requirement is not met as evidenced by: Based on interviews and record reviews, conducted by LPA, the licensee did not comply with the section cited above by failing to notify CCLD regarding R1's hospitalization on or before 05/02/24, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, May 21, 2024

Plan of correction: Licensee shall ensure a written report is submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence of any of the events. R1's incident report shall be submitted to LPA by POC date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst, Melissa Spaeth, conducted an unannounced complaint visit regarding Complaint #31-AS-20240214144751 and Complaint #31-AS-20240214113238. LPA Spaeth was greeted by the caregiver who called the Administrator, Gayane Alaberkyan who stated they were unavailable. LPA requested to see the resident files. The Administrator stated the files were locked in the Administrator's office and the Administrator could not come to the facility to unlock the office. LPA and the caregiver toured the facility at 1:00 until 1:15 pm. At 1:00 pm, LPA observed a needle sitting on the kitchen table. LPA explained the needle should not be sitting out in the open and the caregiver disposed of the needle. The caregiver opened the medication cabinet and stated the lock was broken. LPA observed the medications were not properly locked in the cabinet. Based upon Title 22 Regulations, the following deficiencies are substantiated. (See 809-D page). Exit interview conducted, appeal rights discussed, and a copy of the signed report was given.the state’s words, verbatim · CDSS document, Feb 15, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87755(c) · Plan of correction due date: Feb 16, 2024

87755 Inspection Authority of the Licensing Agency (c) The licensing agency shall have the authority to inspect, audit, & copy resident or facility records upon demand ... This requirement was not met as evidenced by: Based upon LPA's conversation with the Administrator, the resident records are locked in the administrator's office. The Administrator stated staff do not have access to the records.the state’s words, verbatim · CDSS document, Feb 15, 2024

Plan of correction: The Administrator will send copies of the residents' records to LPA Spaeth via email to melissa.spaeth@dss.ca.gov by tomorrow monring, February 16, 2024.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(2) · Plan of correction due date: Feb 15, 2024

87465 Incidental Medical & Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe & locked place that is not accessible to persons other than employees......This requirement was not met as evidenced by:. Based on LPA's observation a needle was sitting on the kitchen table, and the medications were not safely locked in a cabinet. Staff did not comply with the section cited above which poses a potential health, safety & personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 15, 2024

Plan of correction: During LPA's visit, the needle was removed from the premises. The caregiver stated the lock was broken to the medication cabinet. LPA spoke to the Adminstrator the lock must be replaced by tomorrow, 2/15/2024. The Administrator will send a snapshot of the new lock to LPA Spaeth